PATIENT SURVEY

At SUNNYVALE DENTAL CARE, we strive to offer the very best in patient care.
In order to provide that care we turn to our patients for advice.
Please take a moment to complete the patient survey below.
We thank you in advance for your time and participation.
The information below is confidential, and will only be used to improve our service.

1st Visit

Repeat patient (skip to #3)

1.

Was this your first visit to our office or have you been here before?

2.

If you answered "1st Visit," how did you hear about us?

Other:

3.

What was the purpose of your visit?

On a scale of 1 to 5, with 5 being "Great," how would you rate your experience on your last visit? If a particular line does not apply to your visit, please skip it.

Poor

Fair

Okay

Good

Great

4.

Cleanliness/neatness of the waiting room

5.

Friendliness of our office staff

6.

Friendliness of the dentist

If you would like to provide us with your contact information please use the boxes below: